左后分支室性心动过速射频消融术中应用高密度标测电极导管的效果观察  

Application of high-density mapping electrode in radiofrequency ablation of left ventricular posterior fascicular tachycardia

作　　者：宋卫锋 王现青 高传玉 马继芳 臧小彪 陈珂 SONG Wei-feng;WANG Xian-qing;GAO Chuan-yu;MA Ji-fang;ZANG Xiao-biao;CHEN Ke(Cardiac Center,Henan Provincial People's Hospital,Fuwai Central China Cardiovascular Hospital,Zhengzhou University People'sHospital,Zhengzhou,Henan 450003,China)

机构地区：[1]河南省人民医院心脏中心、阜外华中心血管病医院郑州大学人民医院,河南郑州450003

出　　处：《中华实用诊断与治疗杂志》2022年第11期1096-1099,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省医学科技攻关联合共建计划项目(LHGJ20200077,LHGJ20200080);河南省自然科学基金(222102310065)。

摘　　要：目的 观察左后分支室性心动过速(left ventricular posterior fascicular tachycardia, LVPFT)患者射频导管消融术中应用高密度标测电极导管的治疗效果,探讨其安全性。方法 Carto-3系统指导下行射频消融术LVPFT患者42例,19例术中应用DECANAV?高密度电极标测消融靶点者为高密度电极组,23例术中应用消融导管标测消融靶点者为消融导管组。比较2组手术时间、X线曝光时间、放电次数、消融后电轴变化率、即刻成功率及术后并发症发生情况;随访比较术后3、12个月复发情况。结果 2组即刻手术成功率均为100%;高密度电极组手术时间[(74.53±11.47)min]、X线曝光时间[(4.74±1.52)min]均短于消融导管组[(111.74±13.02)、(9.78±1.28)min](t=9.722,P<0.001;t=11.686,P<0.001),放电次数[(5.37±0.76)次]少于消融导管组[(6.70±1.18)次](t=4.214,P<0.001),消融后电轴变化率(57.8%)与消融导管组(52.2%)比较差异无统计学意义(χ^(2)=0.137,P<0.710)。2组术后均未出现明显出血、房室传导阻滞、心包压塞、死亡等并发症。术后3个月,2组复发各2例,给予维拉帕米后转为窦性心律;术后12个月,高密度电极组复发2例,消融导管组复发3例,均再次行射频消融术。结论 LVPFT患者射频导管消融术中应用高密度标测电极导管安全有效,可缩短手术时间及X线曝光时间,减少放电次数。Objective To observe the efficacy of high-density mapping electrode on radiofrequency ablation of left ventricular posterior fascicular tachycardia(LVPFT)and to investigate its safety.Methods Forty-two patients underwent Carto-3 system guided LVPFT ablation,in which 19 patients used DECANAV?high-density electrode(high-density electrode group)and 23 patients used catheter mapping(catheter ablation group).The operation time,X-ray exposure time,discharge frequency,change rate of electrical axis after ablation,immediate success rate and postoperative complications were compared between two groups.The recurrences were compared 3 and 12 months after operation.Results The immediate success rate was 100%in both groups.The operation time and X-ray exposure time were shorter in high-density electrode group[(74.53±11.47),(4.74±1.52)min]than those in catheter ablation group[(111.74±13.02),(9.78±1.28)min](t=9.722,P<0.001;t=11.686,P<0.001),the discharge frequency was less in high-density electrode group[(5.37±0.76)times]than that in catheter ablation group[(6.70±1.18)times](t=4.214,P<0.001),and there was no significant difference in the change rate of electrical axis between two groups(57.8%vs.52.2%)(χ^(2)=0.137,P<0.710).No significant bleeding,atrioventricular block,pericardial tamponade,death or other complications occurred in two groups after operation.Three months after operation,2 patients in each group developed recurrence and were given verapamil for cardioversion.Twelve months after operation,2 patients in high-density electrode group and 3 patients in catheter ablation group developed recurrence,and received radiofrequency ablation again.Conclusion High-density mapping electrode is safe and effective in the radiofrequency ablation of LVPFT,and it can significantly shorten the operation time and X-ray exposure time,and reduce the discharge frequency.

关 键 词：左后分支室性心动过速 射频消融术 高密度电极标测 电生理学 

分 类 号：R541.71[医药卫生—心血管疾病]